Acceptability and Perceived Utility of Telemedical Consultation during Cardiac Arrest Resuscitation. A Multicenter Survey.

Rationale: Many clinicians who participate in or lead in-hospital cardiac arrest (IHCA) resuscitations lack confidence for this task or worry about errors. Well-led IHCA resuscitation teams deliver better care, but expert resuscitation leaders are often unavailable.Objectives: To determine the acceptability and perceived utility of using telemedicine technology to enable remote IHCA resuscitation participation by a critical care physician.Methods: We conducted an electronic, anonymous survey of nurses and attending physicians likely to participate in IHCA resuscitation at 21 hospitals in Utah and Idaho.Results: Complete survey responses were received from 855 (59%) of 1,442 clinicians contacted, of whom 764 met all eligibility criteria. Respondents were more likely to prefer that telemedicine physicians take an active role during IHCA events on the ward (83%; 95% confidence interval [CI], 77-88%) or intensive care unit (ICU; 66% [95% CI, 48-81%]) than the emergency department (53% [95% CI, 44-62%]), with most favorable responses recommending the telemedicine physician act as assistant/advisor ("copilot") for the on-site team. The majority of respondents expected a telemedical copilot for IHCA teams to exert a positive or neutral effect on patient care (51% [95% CI, 44-59%] and 33% [95% CI, 30-37%], respectively). Overall, 41% (95% CI, 31-51%) of respondents favored adding a telemedical critical care physician as IHCA team "copilot," 35% (95% CI, 30-40%) were neutral, and 24% (95% CI, 18-32%) were opposed. Clinicians based at smaller hospitals or on the ward or ICU were most likely to foresee beneficial effects from a telemedicine physician "copilot."Conclusions: ICU- and, especially, ward-based IHCA resuscitation teams at community and rural hospitals were amenable to adding a telemedical critical care physician consultant as IHCA team "copilot." Respondents expected the greatest benefits for IHCA events occurring on the wards.

Contextual Factors Influencing Implementation of Evidence-Based Care for Children Hospitalized With Asthma.

BACKGROUND AND OBJECTIVES: The translation of research findings into routine care remains slow and challenging. We previously reported successful implementation of an asthma evidence-based care process model (EB-CPM) at 8 (1 tertiary care and 7 community) hospitals, leading to a high health care provider (HCP) adherence with the EB-CPM and improved outcomes. In this study, we explore contextual factors perceived by HCPs to facilitate successful EB-CPM implementation. METHODS: Structured and open-ended questions were used to survey HCPs (n = 260) including physicians, nurses, and respiratory therapists, about contextual factors perceived to facilitate EB-CPM implementation. Quantitative analysis was used to identify significant factors (correlation coefficient ≥0.5; P ≤ .05) and qualitative analysis to assess additional facilitators. RESULTS: Factors perceived by HCPs to facilitate EB-CPM implementation were related to (1) inner setting (leadership support, adequate resources, communication and/or collaboration, culture, and previous experience with guideline implementation), (2) intervention characteristics (relevant and applicable to the HCP's practice), (3) individuals (HCPs) targeted (agreement with the EB-CPM and knowledge of supporting evidence), and (4) implementation process (participation of HCPs in implementation activities, teamwork, implementation team with a mix of expertise and professional's input, and data feedback). Additional facilitators included (1) having appropriate preparation and (2) providing education and training. CONCLUSIONS: Multiple factors were associated with successful EB-CPM implementation and may be used by others as a guide to facilitate implementation and dissemination of evidence-based interventions for pediatric asthma and other chronic diseases in the hospital setting.